International journal of geriatric psychiatry · 2026
Psychometric Validation of the Bedford Alzheimer Nursing-Severity Scale in Community-Dwelling Persons With Severe Dementia.
СтатьяМногоцентровое исследованиеВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Cheong Chin Yee, Yap Philip, Ng Tze Pin, Tan Boon Yeow, Malhotra Chetna
Аннотация
OBJECTIVES: Measuring disease severity in persons with severe dementia is essential for clinical care and research. Most instruments encounter issues, for example floor effects in characterising persons with severe dementia. We aimed to evaluate the psychometric properties of the Bedford Alzheimer Nursing-Severity Scale (BANS) and its short version, BANS-6, in community-dwelling persons with severe dementia.
METHODS: We used baseline data from a multi-centre prospective longitudinal study. 215 caregivers of community-dwelling persons with severe dementia (≥ FAST stage 6c) were recruited (mean age 83.6 ± 8.2). We evaluated BANS' construct validity with exploratory factor analysis, correlation with other established measures, and predictive validity.
RESULTS: Factor analysis revealed a two-factor solution (variance 58.35%) with item-2 (sleep-wake cycle) not loading onto any factor. Dropping item-2 (BANS-6) revealed a single-factor solution (variance 49.26%) and Cronbach's α improved from 0.701 to 0.782. FAST did not correlate with the Cohen-Mansfield Agitation Inventory and Quality of Life in Late-Stage Dementia Scale, but both BANS and BANS-6 did. For predictive validity, after adjusting for age, sex and comorbidities, BANS-6 remained significantly associated with key clinical complications of severe dementia: pneumonia (β = 2.09, 95% CI = 0.13-4.05), fever episodes (β = 1.24, 95% CI = 0.10-2.40) and oral antibiotic use (β = 1.33, 95%CI = 0.11-2.55), tube feeding (β = 4.42, 95% CI = 2.62-6.22), pressure sores (β = 2.51, 95% CI = 0.85-4.18), eating problems (β = 3.27, 95%CI = 2.20-4.34), and malnutrition (β = 1.63, 95% CI = 0.24-3.02) in the last 4 months. BANS was not significantly associated with pneumonia, oral antibiotics, and pressure sores, and FAST was not significantly associated with any outcome.
CONCLUSIONS: BANS and its short version, BANS-6, are valid, reliable, and clinically relevant tools for assessing dementia severity in community-dwelling persons with severe dementia, warranting further exploration in diverse population settings. The findings suggest that BANS-6 has better psychometrics and clinical utility than BANS.
METHODS: We used baseline data from a multi-centre prospective longitudinal study. 215 caregivers of community-dwelling persons with severe dementia (≥ FAST stage 6c) were recruited (mean age 83.6 ± 8.2). We evaluated BANS' construct validity with exploratory factor analysis, correlation with other established measures, and predictive validity.
RESULTS: Factor analysis revealed a two-factor solution (variance 58.35%) with item-2 (sleep-wake cycle) not loading onto any factor. Dropping item-2 (BANS-6) revealed a single-factor solution (variance 49.26%) and Cronbach's α improved from 0.701 to 0.782. FAST did not correlate with the Cohen-Mansfield Agitation Inventory and Quality of Life in Late-Stage Dementia Scale, but both BANS and BANS-6 did. For predictive validity, after adjusting for age, sex and comorbidities, BANS-6 remained significantly associated with key clinical complications of severe dementia: pneumonia (β = 2.09, 95% CI = 0.13-4.05), fever episodes (β = 1.24, 95% CI = 0.10-2.40) and oral antibiotic use (β = 1.33, 95%CI = 0.11-2.55), tube feeding (β = 4.42, 95% CI = 2.62-6.22), pressure sores (β = 2.51, 95% CI = 0.85-4.18), eating problems (β = 3.27, 95%CI = 2.20-4.34), and malnutrition (β = 1.63, 95% CI = 0.24-3.02) in the last 4 months. BANS was not significantly associated with pneumonia, oral antibiotics, and pressure sores, and FAST was not significantly associated with any outcome.
CONCLUSIONS: BANS and its short version, BANS-6, are valid, reliable, and clinically relevant tools for assessing dementia severity in community-dwelling persons with severe dementia, warranting further exploration in diverse population settings. The findings suggest that BANS-6 has better psychometrics and clinical utility than BANS.